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. 2021 Mar 15;9(3):2325967121989312.
doi: 10.1177/2325967121989312. eCollection 2021 Mar.

Lower Failure Rates and Improved Patient Outcome Due to Reconstruction of the MCL and Revision ACL Reconstruction in Chronic Medial Knee Instability

Lena Alm  1   2 , Tobias Claus Drenck  1 , Jannik Frings  3 , Matthias Krause  3 , Alexander Korthaus  3 , Anna Krukenberg  3 , Karl-Heinz Frosch  1   3 , Ralph Akoto  1   2   4
Affiliations

Lower Failure Rates and Improved Patient Outcome Due to Reconstruction of the MCL and Revision ACL Reconstruction in Chronic Medial Knee Instability

Lena Alm et al. Orthop J Sports Med. .

Abstract

Background: Concomitant lesion of the medial collateral ligament (MCL) is associated with a greater risk of anterior cruciate ligament (ACL) graft failure.

Purpose: The aim of this study was to compare two medial stabilization techniques in patients with revision ACL reconstruction (ACLR) and concomitant chronic medial knee instability.

Study design: Cohort study; Level of evidence, 3.

Methods: In a retrospective study, we included 53 patients with revision ACLR and chronic grade 2 medial knee instability to compare medial surgical techniques (MCL reconstruction [n = 17] vs repair [n = 36]). Postoperative failure of the revision ACLR (primary aim) was defined as side-to-side difference in Rolimeter testing ≥5 mm or pivot-shift grade ≥2. Clinical parameters and postoperative functional scores (secondary aim) were evaluated with a mean ± SD follow-up of 28.8 ± 9 months (range, 24-69 months).

Results: Revision ACLR was performed in 53 patients with additional grade 2 medial instability (men, n = 33; women, n = 20; mean age, 31.3 ± 12 years). Failure occurred in 5.9% (n = 1) in the MCL reconstruction group, whereas 36.1% (n = 13) of patients with MCL repair showed a failed revision ACLR (P = .02). In the postoperative assessment, the anterior side-to-side difference in Rolimeter testing was significantly reduced (1.5 ± 1.9 mm vs 2.9 ± 2.3 mm; P = .037), and medial knee instability occurred significantly less (18% vs 50%; P = .025) in the MCL reconstruction group than in the MCL repair group. In the logistic regression, patients showed a 9-times elevated risk of failure when an MCL repair was performed (P = .043). Patient-reported outcomes were increased in the MCL reconstruction group as compared with MCL repair, but only the Lysholm score showed a significant difference (Tegner, 5.6 ± 1.9 vs 5.3 ± 1.6; International Knee Documentation Committee, 80.3 ± 16.6 vs 73.6 ± 16.4; Lysholm, 82.9 ± 13.6 vs 75.1 ± 21.1 [P = .047]).

Conclusion: MCL reconstruction led to lower failure rates in patients with combined revision ACLR and chronic medial instability as compared with MCL repair. MCL reconstruction was superior to MCL repair, as lower postoperative anterior instability, an increased Lysholm score, and less medial instability were present after revision ACLR. MCL repair was associated with a 9-times greater risk of failure.

Keywords: MCL reconstruction; MCL repair; chronic medial knee instability; revision ACLR.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: K.H.F. has received educational payments and royalties from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
An imaginary extension of the posterior edge of the tibia and the radiologic crossing with the Blumensaat line was used to find the femoral bone tunnel for the medial collateral ligament reconstruction.
Figure 2.
Figure 2.
The superficial medial collateral ligament and posterior oblique ligament branches were inserted into the tibial bone tunnels below the sartorius fascia and fixed using an interference screw.
See this image and copyright information in PMC

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